Healthy San Francisco – State of Healthhttps://ww2.kqed.org/stateofhealth
KQED Public Media for Northern CAFri, 09 Dec 2016 20:01:11 +0000en-UShourly1https://wordpress.org/?v=4.2.2Life Expectancy Study: It’s Not Just What You Make, It’s Where You Livehttps://ww2.kqed.org/stateofhealth/2016/04/11/life-expectancy-study-its-not-just-what-you-make-its-where-you-live/
Mon, 11 Apr 2016 17:58:02 +0000http://ww2.kqed.org/stateofhealth/?p=171368Poor people who reside in expensive, well-educated cities such as San Francisco tend to live longer than low-income people in less affluent places, according to a study of more than a billion Social Security and tax records.

The study, published in JAMA, the Journal of the American Medical Association, bolsters what was already well known — the poor tend to have shorter lifespans than those with more money. But it also says that among low-income people, big disparities exist in life expectancy from place to place, said Raj Chetty, professor of economics at Stanford University.

“There are some places where the poor are doing quite well, gaining just as much in terms of life span as the rich, but there are other places where they’re actually going in the other direction, where the poor are living shorter lives today than they did in the past,” Chetty said, in an interview with NPR.

For example, low-income people in Birmingham, Ala., live about as long as the rich, but in Tampa, Fla., the poor have actually lost ground.

Chetty and his co-authors collected more than 1.4 billion records from the Social Security Administration and the Internal Revenue Service to try to measure the relationship between income and life expectancy.

“There are vast gaps in life expectancy between the richest and poorest Americans,” Chetty said. “Men in the top 1 percent distribution level live about 15 years longer than men in the bottom 1 percent on the income distribution in the United States.

“To give you a sense of the magnitude, men in the bottom 1 percent have life expectancy comparable to the average life expectancy in Pakistan or Sudan.”

And where life spans are concerned, the rich are getting richer.

Since 2001, life expectancy has increased by 2.3 years for the wealthiest 5 percent of American men and by nearly 3 years for similarly situated women. Meanwhile, life expectancy has increased barely at all for the poorest 5 percent.

Among the study’s findings was that poor people in affluent cities such as San Francisco and New York tend to live longer than people of similar income levels in rust belt cities such as Detroit, he said.

What accounts for the disparity isn’t clear, Chetty says.

It may be that some cities such as San Francisco may be better at promoting healthier lifestyles, with smoking bans, for example, or perhaps people tend to adopt healthier habits if they live in a place where everyone else is doing it, he says.

The study suggests that the relationship between life expectancy and income is not ironclad, and changes at the local level can make a big difference.

“What our study shows is that thinking about these issues of inequality and health and life expectancy at a local level is very fruitful, and thinking about policies that change health behaviors at a local level is likely to be important,” he says.

Chetty notes that the study has clear implications for Social Security and Medicare. The fact that poor people don’t live as long means they are paying into the system without getting the same benefits, a fact that needs to be considered in any discussion about raising the retirement age, he says.

The study was co-authored by Michael Stepner and Sarah Abraham of the Massachusetts Institute of Technology; Benjamin Scuderi, David Cutler and Augustin Bergeron of Harvard University; Shelby Lin of McKinsey and Co.; and Nicholas Turner of the U.S. Treasury Department’s Office of Tax Analysis.

A lot of San Franciscans are saying “no thanks” to the Affordable Care Act. As the cost of living rises in the city, even subsidized health insurance doesn’t feel affordable to many residents.

Supervisor David Campos says that, as a result, not enough people in the city are signing up for health insurance. He wants to change that.

“Without supplemental help, many people won’t get insurance,” he says.

For example, a person who makes less than $46,000/year can get financial assistance from the federal government to help pay the health insurance premium. That subsidy could bring a monthly payment for a silver plan originally quoted at $400 down to $200. But Campos says that’s still too much for many local residents who are struggling to pay skyrocketing rents.

“The subsidies that are provided are the same nationwide. A subsidy of ‘X’ amount in Iowa means something different in San Francisco,” he says.

He will introduce an amendment to San Francisco health law at Tuesday’s board of supervisors meeting. He wants to redirect money that local businesses pay to fund the city’s current health coverage program, Healthy San Francisco, to create additional subsidies. That could potentially cut monthly payments in half again, perhaps bringing monthly premiums under $100, depending on how businesses choose to comply. If passed, the new law will take effect October 1, 2014.

]]>https://ww2.kqed.org/stateofhealth/2014/04/01/how-healthy-san-francisco-could-help-people-buy-obamacare-plans/feed/0RS4616_001-2Future of Healthy San Francisco Unclear in Face of Obamacarehttps://ww2.kqed.org/stateofhealth/2013/10/15/future-of-healthy-san-francisco-murky-in-face-of-obamacare-affordable-care-act/
https://ww2.kqed.org/stateofhealth/2013/10/15/future-of-healthy-san-francisco-murky-in-face-of-obamacare-affordable-care-act/#commentsTue, 15 Oct 2013 17:55:00 +0000http://blogs.kqed.org/stateofhealth/?p=15669Continue reading Future of Healthy San Francisco Unclear in Face of Obamacare→]]>Many San Francisco restaurants pass along at least part of their cost of Healthy San Francisco to patrons. (Angela Hart/KQED)

By Angela Hart

San Francisco is scrambling to figure out how the Affordable Care Act will impact the city’s own landmark universal health legislation, less than three months before the full rollout of Obamacare.

Barbara Garcia, who runs the Department of Public Health, is leading a task force of health experts, business groups and labor leaders who have until the end of November to decipher what health experts are calling confusing and complex details in both the local and national health laws.

“How do you make these two laws correspond?”

“The question for the task force is how do you make these two laws correspond,” said Ken Jacobs, chair of the Labor Center at UC Berkeley who specializes in health policy, and who is also on the task force. “In my view, they correspond quite well, though there’s some work to do around the edges.”

Healthy San Francisco rolled out in 2006 to provide universal health access to the city’s 85,000 uninsured. Today, it covers about 60,000 people.

Now, health experts and city leaders are floating the idea of using Healthy San Francisco monies to help uninsured residents pay their Covered California premiums. Even with federal subsidies available under Obamacare, the cost of insurance may be out of reach for many, they say.

And, experts familiar with Healthy San Francisco say additional financial incentives for consumers will increase the number of young healthy people who sign up for insurance under Covered California, the state’s new health insurance marketplace.

Businesses fund Healthy San Francisco through an “employer spending requirement,” which was bitterly fought by some groups when the law passed. Any business employing 20 or more workers must pay between $1.55 and $2.33 per hour, per employee, as long as the worker puts in at least eight hours a week.

Some businesses can pass off part of that cost. People who eat in San Francisco restaurants, for example, might see this as a line item on their restaurant bill.

“There are some who feel the employer spending requirement should go away,” said San Francisco Supervisor David Campos. “We believe eliminating the employer spending requirement would be a major disaster.”

But prominent business groups such as the San Francisco Chamber of Commerce say they’re worried that using Healthy San Francisco funds could create a different problem —making workers ineligible for Covered California.

“We all want to ensure people get the benefits they’re entitled to under the Affordable Care Act,” said Jim Lazarus, with the San Francisco Chamber of Commerce “But we’re concerned about how the employer spending requirement interacts with the Affordable Care Act.”

Lazarus said the Chamber and other business groups worry that money employers set aside for workers to spend on their health care costs could count as minimum essential coverage, which they say could fulfill the individual mandate under Obamacare guidelines. City leaders are already on the record as saying Healthy San Francisco will not fulfill the Obamacare individual mandate. But there are more questions than answers at this point around meshing Healthy San Francisco with the Affordable Care Act.

“All we’ve been asking for is the city to give us guidance on what employers can do,” Lazarus said. He’s especially concerned about the businesses which do not offer health insurance, but want to comply with the ACA.

Jacobs, the UC Berkeley health policy analyst, says the national health law allows for states and cities to offer additional subsidy programs – exactly what the task force is considering for Healthy San Francisco.

He pointed to similar programs underway in Vermont, Massachusetts and New York that offer financial help for workers who find paying their insurance premium too expensive, even with the federal subsidies.

“Healthy San Francisco could go far in filling in the gaps in the Affordable Care Act,” Jacobs said. He’s especially concerned about low- and middle-income people who can’t afford the premium in the face of the high cost of living in San Francisco. Additional premium subsidies from Healthy San Francisco “could help lower their cost and increase the uptake for Covered California insurance required under ACA.”

Campos has argued since the task force started meeting in July that “what we’re doing in San Francisco is complementary to the Affordable Care Act.”

Yet another key issue is what to do in place of health reimbursement accounts, which are no longer allowed under federal guidelines.

The task force plans to evaluate Healthy San Francisco funding over the next two months. The next meeting is Thursday, Oct. 24. The City says it should have guidance for San Francisco businesses by the end of November.

]]>https://ww2.kqed.org/stateofhealth/2013/10/15/future-of-healthy-san-francisco-murky-in-face-of-obamacare-affordable-care-act/feed/3SCALA’S-2Many San Francisco restaurants pass along at least part of their cost of Healthy San Francisco to patrons. (Angela Hart/KQED)How ‘Healthy San Francisco’ Matters – and Doesn’t – in Obamacarehttps://ww2.kqed.org/stateofhealth/2013/10/07/how-healthy-san-francisco-matters-and-doesnt-in-obamacare/
https://ww2.kqed.org/stateofhealth/2013/10/07/how-healthy-san-francisco-matters-and-doesnt-in-obamacare/#commentsMon, 07 Oct 2013 22:19:18 +0000http://blogs.kqed.org/stateofhealth/?p=15529Fernando Gomez-Benitez, deputy director of San Francisco’s Mission Neighborhood Health Center, is being trained to help enroll San Franciscans in Medi-Cal or Covered California. (Angela Hart/KQED)

By Angela Hart

Government shutdown temporarily aside, effective Jan. 1, 2014, most people need to carry health insurance or pay a fine. It’s called the “individual mandate.”

If you’re signed up with Healthy San Francisco, there’s one very important thing you need to know: Healthy San Francisco is not health insurance. So, it’s not going to get you off the hook for that individual mandate.

A little background: In 2007, San Francisco leaders spearheaded the implementation of universal health care for the city’s estimated 82,000 people who lack health insurance. The idea was to give people access to a range of medical services, including primary care. Participants choose a provider, or “medical home,” from a list exclusively in San Francisco. In the years since, 60,000 people have enrolled.

“We are a leader in delivering health care,” said Barbara Garcia, the director of health for the San Francisco Department of Public Health. “We created Healthy San Francisco to provide care for everyone regardless of their immigration status, their income level, or their health issues.”

Yet, perhaps the biggest difference between Healthy San Francisco and true health insurance coverage is this: If you get any medical care outside the city’s boundaries, you are not covered. Break your leg in Oakland and get treated at Highland Hospital? You’re on the hook for the bill.

That’s a primary reason Garcia and others are aggressively moving Healthy San Francisco participants in a new direction: enrolling them in health insurance. Garcia also points out that federal law requires San Francisco health officials to move patients to other forms of coverage if they are eligible.

“Insurance is better than Healthy San Francisco,” she said. “It’s portable, and it’s more comprehensive care.”

On Jan. 1, most of the 60,000 people currently participating in Healthy San Francisco will become eligible for the Medi-Cal expansion or may qualify for subsidies to purchase insurance on the Covered California marketplace. Right now, for example, childless adults are generally not eligible for Medi-Cal, no matter how low their income is. Under the Medi-Cal expansion, anyone earning less than 138 percent of poverty (about $15,500 for an individual) is eligible. Individuals earning from $15,500 to $46,000 are eligible for subsidies under Covered California.

While Garcia said it’s important to enroll as many residents as possible, transferring thousands of people from Healthy San Francisco to Medi-Cal or Covered California won’t happen overnight.

Still, because of Healthy San Francisco, the city is ahead of most of the state in moving its uninsured population into Medi-Cal or Covered California.

“We know who and where our uninsured are,” Garcia said. “We can send them a letter, we can call them on the phone, we can even text message them. We can get in touch with them to tell them of the changes that are coming with health reform and help them enroll into insurance.”

Challenge in staffing to help people enroll

Reaching those people where they live, work, or access care will be challenging, said John Gressman, who heads up the San Francisco Community Clinic Consortium. The consortium is a network of 13 safety-net clinics — which accounts for roughly half of the city’s clinics that provide indigent care.

“Community clinics in San Francisco are really ready to embrace the new enrollments,” Gressman said. “But one of our primary concerns is that we’re going to have a backlog of people wanting to enroll in coverage, and we’re not going to have the staffing to do it. We are trying to educate people so they don’t become frustrated and angry, and think that it’s not working.”

Meanwhile, officials say Healthy San Francisco is essential to fill in the gaps of Obamacare.

“One of my main concerns is the undocumented,” Gressman said. Undocumented immigrants are explicitly denied benefits under the health law. “That is a large portion of who will remain uninsured, but there are so many others who can’t manage the system. There are people with mental illnesses, people who are homeless.”

Garcia says as many as 20,000 people may be left using Healthy San Francisco, since they won’t qualify for the Affordable Care Act.

“We’ve made a commitment as a sanctuary city to care for all people who live here, even if they have not become residents yet,” said Garcia.

Clinics will benefit under Medi-Cal expansion

As more and more people enroll in Medi-Cal and the exchange, clinics will see new revenue streams from Medi-Cal reimbursement rates and new income sources from the newly insured seeking care. That will help the bottom line for many clinics struggling to keep their doors open, and allow them to continue to provide care for those left out of health care reform, said Fernando Gomez-Benitez, deputy director of Mission Neighborhood Health Center. The center serves about 9,000 people — 98 percent of whom are uninsured.

We “see this as an opportunity to reach more people. That can strengthen the clinic’s mission to serve an indigent population,” Gomez-Benitez said.

]]>https://ww2.kqed.org/stateofhealth/2013/10/07/how-healthy-san-francisco-matters-and-doesnt-in-obamacare/feed/1MNHCFernando Gomez-Benitez, with San Francisco's Mission Neighborhood Health Center is undergoing training to help enroll San Franciscans in Medi-Cal or Covered California. (Angela Hart/KQED)Healthy San Francisco: Snapshot of Universal Carehttps://ww2.kqed.org/stateofhealth/2012/03/01/healthy-san-francisco-snapshot-of-universal-care/
https://ww2.kqed.org/stateofhealth/2012/03/01/healthy-san-francisco-snapshot-of-universal-care/#respondFri, 02 Mar 2012 01:44:19 +0000http://blogs.kqed.org/stateofhealth/?p=3422Jack Snook expresses his appreciation for Healthy San Francisco in a panel discussion last night. (Photo: Kamal Menghrajani)

It’s been almost five years since San Francisco launched its innovative, universal health plan–Healthy San Francisco–and last night a panel of public health experts and care providers gathered at the Tenderloin’s Glide Foundation to provide a snapshot of how the program is faring.

Glide has a long history of providing services to the poor and marginalized–and advocating on their behalf. Glide’s Freedom Hall was packed, with a smattering of people who indicated they were participants in Healthy San Francisco. Tangerine Brigham, director of the program, spoke first and described the program’s goals: to provide improved access to care through a network of community clinics and hospitals. Of primary importance is for people to have a relationship with a doctor or clinic so they don’t resort to the emergency room for what are essentially primary care problems.

Healthy San Francisco has enrolled 80 percent of San Francisco’s uninsured–about 55,000 adults.

Since its inception in 2007, Healthy San Francisco has enrolled 80 percent of San Francisco’s uninsured–about 55,000 adults. And people are using the primary care benefits. “Over 70 percent of the people in Healthy SF are getting a primary care visit at least once a year,” Brigham said. “Because they’re using primary care, we saw a reduction in emergency room utilization at San Francisco General Hospital. We compared that to other public hospitals in California and what that analysis showed was that San Francisco emergency utilization was declining while others’ was rising.”

Healthy San Francisco is not health insurance. Participants pay a quarterly fee–on a sliding scale–for care at the clinics and hospitals that participate in the program, which are in San Francisco only. But people don’t seem to be bothered by the geographic constraints. A 2009 survey by the Kaiser Family Foundation found that 94 percent of participants were at least “somewhat satisfied” with the program and 92 percent would recommend to a friend.

Karen Hill is the clinic manager at Glide Health Services. As a provider, she is also highly satisfied with Healthy San Francisco. “From a clinic manager’s perspective,” she says, “I don’t have to worry about where I need to send someone for specialty care. I know they have a place to go. … We are going to be able to get those specialty tests they need. We have access for blood tests and for medications.”

As part of San Francisco’s health care overhaul, businesses with more than 20 employees are required to provide health insurance to their employees. Before implementation of the plan, employers–especially restaurant owners–had worried that this requirement would cost jobs, since businesses in surrounding cities and counties might not bear the same health insurance costs. William Dow, Professor of Health Economics at UC Berkeley, has looked at this issue extensively. “Were there fewer jobs in the City after this happened?” he asked, in reference to the implementation of Healthy San Francisco. “The answer is no.” You can read his full analysis here.

The discussion was peppered with comments and questions from the audience. Many spoke in favor of Healthy SF, including Jack Snook. “I think Healthy San Francisco is the best thing that ever happened to me other than being a teacher for 20 years,” he said. “I’m able to easily attain care through Healthy SF. … It’s been a big blessing in my life.”

Looking ahead to the rollout of federal health care reform in 2014, panelists agreed that San Francisco’s near-universal health coverage makes the upcoming change easier. “We will be in a very unique position as a provider community in 2014,” said Tangerine Brigham, “because we will be far better prepared with our residents in Healthy San Francisco to transition either from Medicaid or into another program.”

The employer contribution raised relatively modest revenues. Of Healthy San Francisco’s total $177 million budget in the last fiscal year, businesses covered just $12.9 million, or about 7 percent. When city officials created the program they envisioned businesses covering $30 million to $40 million, or at least 15 percent of the cost.

The city’s General Fund picked up nearly eight times that amount — $99.7 million. The contributions of individuals opting to buy Healthy San Francisco for themselves contribute just $5.9 million or a bit more than 3 percent of total costs.

]]>https://ww2.kqed.org/stateofhealth/2012/03/01/healthy-san-francisco-snapshot-of-universal-care/feed/0Jack Snook expresses his appreciation for Healthy San Francisco in a panel discussion last night. (Photo: Kamal Menghrajani)Jack Snook expresses his appreciation for Healthy San Francisco in a panel discussion last night. (Photo: Kamal Menghrajani)Healthy SF: Not So Healthy Financiallyhttps://ww2.kqed.org/stateofhealth/2011/11/16/healthy-sf-not-so-healthy-financially/
https://ww2.kqed.org/stateofhealth/2011/11/16/healthy-sf-not-so-healthy-financially/#commentsWed, 16 Nov 2011 21:53:32 +0000http://blogs.kqed.org/stateofhealth/?p=302(Flickr:a.drian)

Four years ago, the City of San Francisco launched an ambitious attempt at health care coverage for all. Today, the San Francisco Public Press devotes its winter edition to an analysis of how well “Healthy San Francisco” is working. While tens of thousands of previously uninsured people have enrolled, and now have health care access they did not have before, the costs have been daunting.

In the Public Press report Stephen Shortell, Dean of the UC-Berkeley School of Public Health appropriately summarized the problem, “Healthy San Francisco is a model for health care delivery, but not for payment.”

“The program is very, very important, but I think we should recognize that it does not pay for the care of the population.”

Healthy SF is not insurance. Instead, it is access to community clinics and other safety net providers, but only those in San Francisco. Participants are not covered if they visit providers outside San Francisco. It is largely uninsured adults, people who earn too much money to qualify for Medi-Cal, who have signed up. In a state where more than 20 percent of people lack health insurance, only three percent of San Franciscans now are without health care. The Public Press reports that many people who had not seen a doctor in years are now receiving treatment.

But, in its detailed report, the Public Press gets at the strains on community clinics.

Participating nonprofit community clinics in the network have been shouldering part of the financial burden. That may be a problem in an economy where health care costs are rising twice as fast as inflation. Some clinics say they are tapped out, and the $114 per-patient per-year reimbursement they get from Healthy San Francisco doesn’t come anywhere close to covering costs.

“The program is very, very important,” said Karen Hill, administrative director of Glide Health Services, a large, busy nonprofit community health clinic in the Tenderloin whose base of 3,000 patients includes 1,500 Healthy San Francisco members. “But I think we should recognize that it does not pay for the care of the population.”

At last count, Healthy San Francisco covers 54,348 patients, about two-thirds of the estimated 82,000 San Francisco adults who lack insurance, according to a September report from Mathematica Policy Research of Princeton, New Jersey. (Estimates range widely from 64,000 to 90,000 uninsured adults aged 18 to 64.)

In a survey of patient satisfaction, 94 percent said they were satisfied with the medical care they received through the program.

But clinic directors say that while the program has been great for patients, the clinics themselves struggle to deliver care to ever-growing numbers of people. Some clinics have seen their patient base grow by a third since 2007.

Healthy San Francisco has laudable goals, said Ricardo Alvarez, medical director of the Mission Neighborhood Health Center, and “has expanded care to a vulnerable underserved population.”

But for clinics to make it work, Alvarez said, “it is challenging financially.”

Several clinics, such as Lyon-Martin Health Services in Hayes Valley, have stopped taking more Healthy San Francisco patients. The center was already under financial stress this year, and announced earlier this year it had been on the brink of bankruptcy.

Public Press details the different funding streams and explains the budgetary shortfalls. But it also points to potential savings.

Shifting to the patient-centered model has also dramatically cut the use of city emergency rooms for routine care by the program’s participants. Proponents say that in the long run emergency room “diversion” — catching illness before it becomes acute — has the potential to save the city millions of dollars a year because emergency care is inevitably more expensive.

Public Press doesn’t address how great those potential savings could be, but it seems unlikely that ER diversions would save enough to offset the cost of covering tens of thousands of people in community clinics.